Permit C ITY OF TIGARD PLUMBING PERMIT
& DEVELOPMENT SERVICES PERMIT #: PLM2004 -00458
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/1/2004
SITE ADDRESS: 12079 SW WHISTLER'S LP PARCEL: 2S103CC -13800
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R-4.5
BLOCK: LOT: 085 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 10/1/2004 $36.25
STE 100 [TAX] 8% State Surchari 10/1/2004 $2.90
LAKE OSWEGO, OR 97035 Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 - 692 - 5945 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: I o oi1Y Permittee Signature: 2 mil\
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. Building R
g Fixtures G``' V Plumbing Permit App it.' • . CO \j
FOR OFFICE USE ONLY
City of Tigard 1°' Reccivea
13125 SW Hall Blvd.. Tigard, OR 97223 SEP 3 �p Plan Review
9 0'0� /fi t No ) l.��G5c j' y4
Phone: 503.639.4171 Fax: 503.598.1960 .11 - `,•., Plan Review
24- Hour Inspection Line: 503.639.4175 G`� O` `� 1,/ I , ,V Date/By: Other Permit No.:
Internet: www.ci.tigard.or.tts
� l j = = - Ready/By:
Internet: ®See for
� pE•' ``a. Nodfied/Med.d: ( $applemeo W 2 laformation
: FEE* SCHEDULE
New construction 0 Demolition -' For special information use checklist
El Addition /alteration/replacement Description
❑ Other: I Qty. I Ea. 1 Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.. 0. 1CATEGoRY . ". SFR (1) bath
� 249.20
.: ".... �_.,•, ... _ .... ..:. . , . :. I
�- and 2- family dwelling 0 Commercial/industrial SFR (2) bath
❑ Accessory building 350.00
❑ Multi-family SFR ( bath 399.00
❑ Master builder Other: Each additional bath/kitchen 45.00
• • . ~•'• -.. • • JO$ S , 91 T °4 * - .AL11 L•O T[ON • Fite sprinkler ( sq. R) Page 2
Site utilities
lob site address: ! a U 79 SUS ID b is f - fe c es 1 W � I
� Catch basin or area drain I 16.60
City/State/ZIP: •-j- Q �Lc,(� OK G(--7 2-2-3 J 16.60 {
Drywall, leach line, or trench drain
Suitelbldgiapt no.: I Project name: l�h'1 S f /{ r ()jai K �_ - Footing drain (no. linear ft.: Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
s (,�� �' rn T 4,42-0 Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision,} , •i-�ey$ Walk, E. L ( Lot no.: irS Water service (no. linear R.. ) Page 2
Tax map /parcel no.: ( Sty_ gs' Fixture or item
''DESERIPTIOIV OF WORK Absorption valve 16.60
Backflow preventer ! Page 2 a-7 SS
i_cc/)4SCCt/ % rr, ( { � k f1 i t ,..;/,-/)//' r Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
-; P RbYERTY QWHIER I • '., ' �. : . r Drinking fountain 16.60
Name: �� /�'Y! S S r.._ ... _ Ejeetots/sutttp 16.60
C i 74 # ` - /17 t ' j Expansion tank 16.60
Address: Z-tc„). 3 G ,S Ltj 6 ' - - c W 0 oc , Fixture/sewer cap 16.60
Ciry/State/n iF: (.-C& /< C C t V e 410 0 A' - y •7 L3.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax ( ) Garbage disposal 16.60
- , ._ 1PPaCQLIT . ' `. CONTACF •PERSON Hose bib 16.60
Business name: c Ice maker 16.60
L tt.n t[ s cite -. Greg ern Tr-) G
Contact name r'" .• Interceptor/grease trap 16.60
.• ! `� Se ai -` Medical gas (value: S ) Page 2
Address: / 310 G 4-11.) r v..4 /(111 12 •[) Primer 16 60
City/State/ZZIP :•-j (L O it• , G2 • I' W...uri Roof drain (commercial) 16.60
Phone: (54'3) (L e /e9 - J�%C f 5 ( Fax: : (.5 s) (' Y:a - C' 'J ( G .sue Sink/basin/lavatory 16.60
E -mail: Tub/shower /shower pan 16.60
Urinal 16.60
• ' _ - :'CONTRACTOR ' " ' . • •, . • _ Water closet
16.60
Business name:L.144Se‘,/,').(.... 07-94/7-1 n r -/) Water heater 16.60
Address: /,�" '"00 S ii J /Y1 y.S•l Gri /LLB Other: I
City/State/ZIP: w(f,tC 7rt -0,e. t:/ /�Q -q706, y Subtotal
Phone: ('t�[i Ioo2 S
3) Y Fax: / Minimum permit fee: 572.50
s 603i C ,4Q - 074 g' Residential back low minimum permit fee: 536.25 3 to. aS
CCB Lic.: 7 it) Plumbing Lie. no.: Plan review 25 /o of ( ° permit fee)
Authorized signs •- - ' ,G/ 6 �, `/u7 State surcharge (8% of permit fee) • 90 Print name � l TOTAL PERMIT FEE 3qr /S
(,Ll�, Dart. .3c) / I) This permit application expires if a permit is not obtained %, ithin
lJ 180 days after It has been accepted as complete.
�� *Fee methodology set by Tri -County Building Industry Service Board.
Tura Pmmi[App.doc 17/07
44046 16T tY07lOOtN/INE13)
-- Z � - eEb. =90 b0 OE daS
CITY OF TIGARD 24 -Hour
BUI�DINi Inspection Line: (503) 639 -4175 ,
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST fs6 qf
Received equested • AM PM BUP
Location • • uite MEC
Contact Person Ph ( —6 - PLM 5' /� — dflC4S-
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes G�2�� SIT
Post & Beam � /[
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
• Insulation 5 � --
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
ART FAIL
PL
earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n „ ✓
Other
Fin
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE • El Please call for reinspection RE: n Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date I�� p 7 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL